Emmanuel Gonzalez, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00861800 Issued in NJ

Practice address

511 S Orange Ave
South Orange, NJ 07079-2636

Phone

(973) 762-4720

Fax

(973) 762-3731

NPI assigned

Jul 8, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Essex Renal and Medical Group,LLCGroup PAC ID 5294708095, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Essex Renal & Medical Group,LLC

  • Nephrology Physician
  • South Orange, NJ
  • NPI 1972545648
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1386480481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 S ORANGE AVE",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792636",
            "telephone_number": "973-762-4720",
            "fax_number": "973-762-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 S ORANGE AVE",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792636",
            "telephone_number": "973-762-4720",
            "fax_number": "973-762-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "EMMANUEL",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00861800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodger Goddard, PH.D.
• Neil Ellis Goldberg, D.P.M.
• Golden Path Services
• Goldson Medical Associates, LLC
• Debra N Goldson-Prophete, MD
• Mark Alastair Graham, LCSW
• Katheryn Grajales
• Ralph Charles Gray Sr., DDS
• Robin Beth Greenberg, LSW
• Growth Counseling Center

• Medical Physician Assistant in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.